Insurance Marketplace “Navigators” Spark Debate

As specifics about the health insurance exchanges continue to come out, opponents continue to scrutinize and criticize regulations. The most recent concerns, according to CQ, come from Republicans who are worried about the role that “navigators” will play in the marketplace.

NAHAM has previously written about the idea of navigators; people that will help customers choose which insurance plan to pick, and will help determine whether they are eligible for Medicaid or tax credits. The navigators are needed because “many people who would buy insurance through the marketplace have never had insurance before, and will need help in choosing the right plan” says Gary Cohen, director of the HHS Center for Consumer Information and Insurance Oversight.

Congressman Tim Murphy (R-PA), a member of the House committee on Energy and Commerce, agrees that there needs to be a helper, but disagrees with HHS’s idea. Currently, HHS plans to fund the navigators with $54 million in grants that will be spread across the 33 states that have a federally run exchanges or a state-federal partnership. Murphy announced a hearing that the role can be filled by insurance brokers, paid by private sector companies instead of the federal government.  

HHS disagrees with Murphy, stressing the need for the navigators to be independent. Otherwise, they fear, brokers will be more focused on selling their company’s plan to the customer, even when it may not be the right plan for them. Regulations set down by HHS bar licensed brokers and insurance agents from acting as navigators, but allows them to assist people in signing up for coverage. This approach worries some Republicans who fear that those experienced in the insurance industry will not be able to help, leaving the navigator roles to be filled by inexperience newcomers.

These navigators will finish their training in August before the public starts seeing eligible plans in September. The open enrollment period begins in October, and all marketplace plans will cover individuals beginning January 2014.